Importance of antenatal care

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Information about Importance of antenatal care
Health & Medicine

Published on March 2, 2012

Author: abir33

Source: slideshare.net

Description

Importance of antenatal care: prepared by Abir Chowdhury, Chittagong, Bangladesh

Importance of Antenatal care Presented by: Captain Nishat Fatema Nipun MBBS (AFMC) MO, CMH, Chittagong, Bangladesh

What is Antenatal care Periodic and regular supervision including examination and advice of a woman during pregnancy is called Antenatal care. The supervision should be of a regular and periodic nature in accordance with the need of the individual.

Periodic and regular supervision including examination and advice of a woman during pregnancy is called Antenatal care.

The supervision should be of a regular and periodic nature in accordance with the need of the individual.

Aims The aims are- To screen the high risk cases To prevent or detect or treat at the any earliest complication To ensure continued medical surveillance and prophylaxis To educate the mother about the physiology of pregnancy and labour by demonstrations, charts and diagrams so that fear is removed and psychology is improved

The aims are-

To screen the high risk cases

To prevent or detect or treat at the any earliest complication

To ensure continued medical surveillance and prophylaxis

To educate the mother about the physiology of pregnancy and labour by demonstrations, charts and diagrams so that fear is removed and psychology is improved

Aims (cont’d) To discuss with the couple about the place, time and mode of the delivery, provisionally and care of the newborn To motivate the couple about the need of family planning To advice the mother about breast-feeding, post-natal care and immunization

To discuss with the couple about the place, time and mode of the delivery, provisionally and care of the newborn

To motivate the couple about the need of family planning

To advice the mother about breast-feeding, post-natal care and immunization

Objectives To ensure a normal pregnancy with delivery of a healthy baby from a healthy mother

To ensure a normal pregnancy with delivery of a healthy baby from a healthy mother

Criteria of normal pregnancy Delivery of a single baby in good condition at term with no maternal complication

Delivery of a single baby in good condition at term with no maternal complication

Services As per WHO recommendation at least 4 visit- 1 st visit around 16 weeks 2 nd visit between 24-28 weeks 3 rd visit at 32 weeks 4 th visit at 36 weeks

As per WHO recommendation at least 4 visit-

1 st visit around 16 weeks

2 nd visit between 24-28 weeks

3 rd visit at 32 weeks

4 th visit at 36 weeks

Services (cont’d) Generally- At interval of 4 weeks up to 28 weeks At interval of 2 weeks up to 36 weeks At weekly interval up to EDD

Generally-

At interval of 4 weeks up to 28 weeks

At interval of 2 weeks up to 36 weeks

At weekly interval up to EDD

Antenatal care comprises of- Careful history taking and examination and investigation Advice given to the pregnant woman

Careful history taking and examination and investigation

Advice given to the pregnant woman

THE FIRST VISIT History taking Examination Investigation

History taking

Examination

Investigation

History taking Particulars of the patient Chief complaints with duration Past history Obstetric history Menstrual history Family history Drug History History of immunization Socio-economic history Contraceptive history History of allergy

Particulars of the patient

Chief complaints with duration

Past history

Obstetric history

Menstrual history

Family history

Drug History

History of immunization

Socio-economic history

Contraceptive history

History of allergy

Particulars of the patient Name Age Address Marital status Date of Admission Date of Examination

Name

Age

Address

Marital status

Date of Admission

Date of Examination

Chief complaints with duration Period of amenorrhea Nausea & vomiting, vertigo Increased frequency of micturition Constipation Heaviness of breast Rise of temperature Edema Pain in the abdomen Backache Vaginal bleeding

Period of amenorrhea

Nausea & vomiting, vertigo

Increased frequency of micturition

Constipation

Heaviness of breast

Rise of temperature

Edema

Pain in the abdomen

Backache

Vaginal bleeding

Past history HTN DM BA Renal Disease Psychiatric illness IHD Any previous operation

HTN

DM

BA

Renal Disease

Psychiatric illness

IHD

Any previous operation

Obstetrical History Duration of marriage Gravida Para ALC

Duration of marriage

Gravida

Para

ALC

Menstrual History Age of menarche Menstrual period Menstrual cycle LMP EDD

Age of menarche

Menstrual period

Menstrual cycle

LMP

EDD

Family history HTN DM Multiple pregnancy

HTN

DM

Multiple pregnancy

Drug History Antihypertensive Hypoglycemic Antidepressant Corticosteroid Anticoagulant

Antihypertensive

Hypoglycemic

Antidepressant

Corticosteroid

Anticoagulant

Physical examination General examination Abdominal examination

General examination

Abdominal examination

General examination Appearance Height of patient Weight of patient Anemia Jaundice Edema Cyanosis Clubbing Koilonychia Leuconychia

Appearance

Height of patient

Weight of patient

Anemia

Jaundice

Edema

Cyanosis

Clubbing

Koilonychia

Leuconychia

General examination (cont’d) Temperature Pulse BP RR Breast Heart sound Lungs

Temperature

Pulse

BP

RR

Breast

Heart sound

Lungs

Abdominal examination Inspection Palpation percussion Auscultation

Inspection

Palpation

percussion

Auscultation

Inspection Shape of the uterus Striae scar mark

Shape of the uterus

Striae

scar mark

Palpation Assessment of fundal height Lie Abdominal girth Fundal grip Lateral grip First pelvic grip Second pelvic grip

Assessment of fundal height

Lie

Abdominal girth

Fundal grip

Lateral grip

First pelvic grip

Second pelvic grip

Auscultation Normal FHR is 120-160 b/m Causes of foetal tachycardia (>160 b/m) Causes of foetal bradycardia (<120 b/m)

Normal FHR is 120-160 b/m

Causes of foetal tachycardia (>160 b/m)

Causes of foetal bradycardia (<120 b/m)

Causes of foetal tachycardia (>160 b/m) Maternal high fever Foetal distress Maternal tachycardia

Maternal high fever

Foetal distress

Maternal tachycardia

Causes of foetal bradycardia (<120 b/m) Foetal distress Foetal cardiac conduction defect

Foetal distress

Foetal cardiac conduction defect

Investigation CBC Blood grouping & Rh typing Urine R/E RBS VDRL HBS Ag Ultrasound

CBC

Blood grouping & Rh typing

Urine R/E

RBS

VDRL

HBS Ag

Ultrasound

Ultrasound early pregnancy (preferably at 10-13 weeks) to: Determine gestational age Detect multiple pregnancies Help with later screening for Down's syndrome

early pregnancy (preferably at 10-13 weeks) to:

Determine gestational age

Detect multiple pregnancies

Help with later screening for Down's syndrome

Ultrasound (cont’d) At 11-14 weeks: offer nuchal translucency screening for Down's syndrome, with other tests if available. At 18-20 weeks: offer screening with ultrasound for congenital anomalies. At 36 weeks: for foetal maturity, placenta praevia.

At 11-14 weeks:

offer nuchal translucency screening for Down's syndrome, with other tests if available.

At 18-20 weeks:

offer screening with ultrasound for congenital anomalies.

At 36 weeks:

for foetal maturity, placenta praevia.

In subsequent visit Patient complains General examination Gestational age to be calculated Identification of problem Foetal movement SFH measurement Health education Prophylaxis & treatment of anemia Developing individualized birth plan

Patient complains

General examination

Gestational age to be calculated

Identification of problem

Foetal movement

SFH measurement

Health education

Prophylaxis & treatment of anemia

Developing individualized birth plan

Second visit (24-28 weeks) SFH measurement To detect Multiple pregnancy

SFH measurement

To detect Multiple pregnancy

Third visit (32 weeks) Screen for- Preeclampsia Multiple pregnancy anemia IUGR

Screen for-

Preeclampsia

Multiple pregnancy

anemia

IUGR

Fourth visit (36 weeks) Identification of foetal Lie Presentation Position Update birth plan

Identification of foetal

Lie

Presentation

Position

Update birth plan

Antenatal advice Principles: To impress the patient about the importance of regular check up To maintain or improve the health status of the woman to the optimum till delivery by judicious advice regarding diet, drugs and hygiene To improve and tone up the psychology and ot remove the fear of pregnancy by talking sympathetically to the patient and explaining the principle changes and events likely to occur during pregnancy

Principles:

To impress the patient about the importance of regular check up

To maintain or improve the health status of the woman to the optimum till delivery by judicious advice regarding diet, drugs and hygiene

To improve and tone up the psychology and ot remove the fear of pregnancy by talking sympathetically to the patient and explaining the principle changes and events likely to occur during pregnancy

Antenatal advice (cont’d ) Diet Rest & sleep Bowel Personal cleanliness Clothing, shoes & belt Dental care Care of breast Coitus Travelling Smoking & alcohol Immunization Drug Mental preparation Exercise Child care Birth plan Warning sign Family planning Following advices are to be given:

Diet

Rest & sleep

Bowel

Personal cleanliness

Clothing, shoes & belt

Dental care

Care of breast

Coitus

Travelling

Smoking & alcohol

Immunization

Drug

Mental preparation

Exercise

Child care

Birth plan

Warning sign

Family planning

Diet Diet should be: nutritious balanced light easily digestible rich in protein, mineral and vitamin with woman’s choice

Diet should be:

nutritious

balanced

light

easily digestible

rich in protein, mineral and vitamin

with woman’s choice

DDA of a woman during pregnancy (2 nd half) Food element pregnancy Kilocalories 2500 Protein 60 gm. Iron 40 mg Folic acid 400  g Calcium 1000 mg Vitamin A 6000 I.U.

Diet for a pregnant woman (3000 Kcal) Early morning: Tea or coffee – 1 cup Biscuit – 2 pcs Breakfast: Chapatties – 2 pcs Egg – 1 poached or boiled Vegetable – 1 cup Midmorning: Milk – 250 ml or 1 glass Biscuit – 2 pcs Apple or orange – 1 pc

Early morning:

Tea or coffee – 1 cup

Biscuit – 2 pcs

Breakfast:

Chapatties – 2 pcs

Egg – 1 poached or boiled

Vegetable – 1 cup

Midmorning:

Milk – 250 ml or 1 glass

Biscuit – 2 pcs

Apple or orange – 1 pc

Diet for a pregnant woman (3000 Kcal) Lunch: Cooked rice – 4 cup Meat or fish – 3 pcs or 120 gm. Cooked Dal – 2 cups Vegetable – 1 cup Leafy vegetable – ½ cup Salad – tomato, carrot, cucumber

Lunch:

Cooked rice – 4 cup

Meat or fish – 3 pcs or 120 gm.

Cooked Dal – 2 cups

Vegetable – 1 cup

Leafy vegetable – ½ cup

Salad – tomato, carrot, cucumber

Evening: Biscuits – 2 pcs Fruits – on choice Dinner: Cooked rice – 3 cup Meat or fish – 3 pcs or 120 gm. Cooked Dal – 2 cups Vegetable – 1 cup Bed time: one glass of milk Diet for a pregnant woman (3000 Kcal)

Evening:

Biscuits – 2 pcs

Fruits – on choice

Dinner:

Cooked rice – 3 cup

Meat or fish – 3 pcs or 120 gm.

Cooked Dal – 2 cups

Vegetable – 1 cup

Bed time: one glass of milk

Early morning: Tea or coffee – 1 cup (without sugar) Salted Biscuit – 2 pcs Breakfast: Chapatties – 2 pcs / Atta – 60 gm. Egg – 1 poached or boiled Vegetable – ½ cup Milk – 150 ml or 1 cup Midmorning: apple or sweet lime Diet for a pregnant diabetic woman (2200 Kcal)

Early morning:

Tea or coffee – 1 cup (without sugar)

Salted Biscuit – 2 pcs

Breakfast:

Chapatties – 2 pcs / Atta – 60 gm.

Egg – 1 poached or boiled

Vegetable – ½ cup

Milk – 150 ml or 1 cup

Midmorning: apple or sweet lime

Lunch: Cooked rice – 1.5 cup / rice – 60 gm. Meat or fish – 1 pcs or 40 gm. Cooked Dal – 1 cup Leafy vegetable – ½ cup Salad – tomato, carrot, cucumber Evening: (4 pm) Salted Biscuits – 2 pcs Milk – 150 ml or 1 cup Diet for a pregnant diabetic woman (2200 Kcal)

Lunch:

Cooked rice – 1.5 cup / rice – 60 gm.

Meat or fish – 1 pcs or 40 gm.

Cooked Dal – 1 cup

Leafy vegetable – ½ cup

Salad – tomato, carrot, cucumber

Evening: (4 pm)

Salted Biscuits – 2 pcs

Milk – 150 ml or 1 cup

Dinner: Chapatties – 3 pcs / Atta – 90 gm. Meat or fish – 1 pcs or 40 gm. Cooked Dal – 1 cup Vegetable – ½ cup Bed time: one cup of milk Diet for a pregnant diabetic woman (2200 Kcal)

Dinner:

Chapatties – 3 pcs / Atta – 90 gm.

Meat or fish – 1 pcs or 40 gm.

Cooked Dal – 1 cup

Vegetable – ½ cup

Bed time: one cup of milk

Restricted food: sugar Molasses Honey Jam / jelly Sweet Chocolate Ice-cream juice Diet for a pregnant diabetic woman (2200 Kcal)

Restricted food:

sugar

Molasses

Honey

Jam / jelly

Sweet

Chocolate

Ice-cream

juice

Rest and sleep 8 hour sleep at night At least 2 hour sleep after mid-day meal Hard strenuous work should be avoided in first trimester and last 4 weeks

8 hour sleep at night

At least 2 hour sleep after mid-day meal

Hard strenuous work should be avoided in first trimester and last 4 weeks

Bowel Regular bowel movement may be facilitated by regulation of diet, taking plenty fluid, vegetable and milk Coitus Should be avoided in 1 st trimester last 6 weeks

Regular bowel movement may be facilitated by regulation of diet, taking plenty fluid, vegetable and milk

Should be avoided in

1 st trimester

last 6 weeks

Travelling Should be avoided in 1 st trimester last 6 weeks Air travelling is contraindicated in Placenta praevia Preeclampsia Severe anemia

Should be avoided in

1 st trimester

last 6 weeks

Air travelling is contraindicated in

Placenta praevia

Preeclampsia

Severe anemia

Immunization Indicated- TT HAV HBV Rabies Contraindicated- Live virus vaccine (rubella measles, mums, varicella)

Indicated-

TT

HAV

HBV

Rabies

Contraindicated-

Live virus vaccine (rubella measles, mums, varicella)

Warning sign Headache Blurring of vision Convulsion Vaginal bleeding Fever

Headache

Blurring of vision

Convulsion

Vaginal bleeding

Fever

Preconceptional care Preconceptional care is the one step ahead of antenatal care. When a couple is seen and counseled about pregnancy, its course and outcome before the time of actual conception, is called Preconceptional care. Objective: to ensure that, a woman enters pregnancy with an optimal state of health which would be safe both to herself and the fetus.

Preconceptional care is the one step ahead of antenatal care.

When a couple is seen and counseled about pregnancy, its course and outcome before the time of actual conception, is called Preconceptional care.

Objective: to ensure that, a woman enters pregnancy with an optimal state of health which would be safe both to herself and the fetus.

Preconceptional care includes: Identification of high risk factor Basal level health status including BP recording Rubella & Hepatitis immunization Folic acid supplementation Maternal health is optimized preconceptionally such as overweight anemia Patient with medical disease like hypertension, diabetes are stabilized in an optimal state by intervention

Identification of high risk factor

Basal level health status including BP recording

Rubella & Hepatitis immunization

Folic acid supplementation

Maternal health is optimized preconceptionally such as overweight anemia

Patient with medical disease like hypertension, diabetes are stabilized in an optimal state by intervention

Preconceptional care includes: (cont’d) Drugs used before pregnancy are verified and changed if required to prevent any adverse effect of the fetus; e.g., warfarin is replaced with heparin, oral anti-diabetic drug with insulin Advise to stop smoking, alcohol and drug abuse Proper counseling to those with history of recurrent foetal loss or family history of congenital abnormalities Counseling regarding health care cost Find out supporting or helping people to help the mother and care of the new born

Drugs used before pregnancy are verified and changed if required to prevent any adverse effect of the fetus; e.g., warfarin is replaced with heparin, oral anti-diabetic drug with insulin

Advise to stop smoking, alcohol and drug abuse

Proper counseling to those with history of recurrent foetal loss or family history of congenital abnormalities

Counseling regarding health care cost

Find out supporting or helping people to help the mother and care of the new born

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